Oscillation frequency of skin microvascular blood flow is associated with mortality in critically ill patients

• Published in: Acta anaesthesiologica Scandinavica Vol. 51; no. 6; pp. 701 - 707
• Main Authors: Knotzer, H., Maier, S., Dünser, M., Stadlbauer, K. H., Ulmer, H., Pajk, W., Hasibeder, W. R.
• Format: Journal Article
• Language: English
• Published: Oxford, UK Blackwell Publishing Ltd 01-07-2007; Blackwell
• Subjects: Adult; Aged; Anesthesia; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; Blood Flow Velocity; Critical Illness - mortality; Flow motion; Humans; Hyperemia - etiology; Medical sciences; microcirculation; Microcirculation - pathology; Microcirculation - physiopathology; Middle Aged; multiple organ dysfunction; outcome; reactive hyperemia; Regional Blood Flow; Respiration, Artificial; Sepsis; Shock, Septic; Skin - blood supply; Survival Analysis; Survivors; Human; Prognosis; Critically ill; Oscillation frequency; Mortality; Blood flow; Reactive hyperemia; Microcirculation; multiple organ dysfunction; Anesthesia; Skin; Flow motion; outcome
• ISSN: 0001-5172; 1399-6576
• DOI: 10.1111/j.1399-6576.2007.01336.x

Background:  Microcirculatory dysfunction has been hypothesized to play a key role in the pathophysiology of multiple organ failure and, consequently, patient outcome. The objective of this study was to investigate the differences in reactive hyperemia response and oscillation frequency in surviving and non‐surviving patients with multiple organ dysfunction syndrome.
Methods:  Twenty‐nine patients (15 survivors; 14 non‐survivors) with two or more organ failures were eligible for study entry. All patients were hemodynamically stabilized, and demographic and clinical data were recorded. A laser Doppler flowmeter was used to measure the cutaneous microcirculatory response. Reactive hyperemia and oscillatory changes in the Doppler signal were measured during 3 min before and after a 5‐min period of forearm ischemia.
Results:  Non‐survivors demonstrated a significantly higher multiple organ dysfunction score when compared with survivors (P= 0.004). Norepinephrine administration was higher in non‐survivors (P= 0.018). Non‐survivors had higher arterial lactate levels (P= 0.046), decreased arterial pH levels (P= 0.001) and decreased arterial Po2 values (P= 0.013) when compared with survivors. A higher oscillation frequency of the skin microvasculature at rest (P= 0.033) and after an ischemic stimulus (P= 0.009) was observed in non‐survivors. The flow motion frequency observed in reactive hyperemia was associated with the severity of multiple organ dysfunction (P= 0.009) and, although not statistically significant, with the arterial lactate concentration (P= 0.052).
Conclusion:  Increased skin microvascular oscillation frequency at rest and in the hyperemic state after an ischemic stimulus is associated with increased mortality in patients suffering from multiple organ dysfunction. The underlying mechanism could be a response of the skin microvasculature to an impaired oxygen utilization of the skin tissue.